USMLE step 2 questions - How we fail medical students with bad questions 

Med school taught me that Burkitt Lymphoma has a translocation of the MYC gene, but not that type 2 diabetes is caused by eating junk food.

Keep in mind you have 1.5 minutes for this question and 319 more to go

Vinay, when I was a practising Histopathologist I was sent an experimental test by the British College of Pathology to see what I thought of it. My answer was this. "I can answer some of these questions and not others. All these questions have one thing in common. Not a single one of them has knowledge which is of any use I can think of to a practical diagnostic histopathologsist." I, on the other hand, being such a practitioner would have no problem asking questions which would all be relevant. Conclusion. The tests should be set by those who do, not those who talk a lot.

It's because Step exams are bout STRATIFICATION, not CERTIFICATION. I'm learning that the hard way right now as a medical student lol

A lot of questions have ivory tower answers that don't apply to reality, either.

Dr Prasad, current US MD student here who also acknowledges that I’m paying loads of money to practice my pattern/buzzword recognition skills. With that said, would you be willing to write two or three questions yourself that you believe would be valuable for medical students and make a video going over them and explaining why they’re better than the ones here? Would love the opportunity to see what valuable questions from a practicing physician would look like. Thanks!

I love how VP despises and disapproves of the vast and varied medical incompetencies. Does his health improve by degrees as he vents his exasperation? I think it does! And he helps civilization as well.

The reason why there is so much inane medical trivia on step is so that it can act as a stratification tool for resident selection. If they just tested on medically relevant topics, the test would be too easy, and everyone would get a high score. Program directors would probably get upset after a while and request a new standardized metric to screen large numbers of applicants quickly. People get better at taking the MCAT, Step exams, etc., every year. Considering it's a knowledge-based exam, the way they can continue to create a nice bell curve is to throw in arcane topics that only the sweatiest medical students will be able to answer.

I've never felt better as a 4th year med student trying to go into ophthalmology than knowing the answer to that last question lol. Sketchy for the win!

My suggestion for endless criticism from Vinay. Create your own question bank and teach students relevant clinical medicine.

I can’t tell you how many med school graduates look at me like I’m an alien when I ask them to give me a definition of the word “diagnosis.” No one has asked before! And unsurprisingly, a good number don’t know what it means to arrive at a coherent diagnostic conclusion. The notes contain random clinical facts but no insight into the patient’s pathology. Presentation is all over the place. At internship. Some others are really good to be sure but there are interns who definitely should not have graduated.

Be careful giving out the student’s identity . Definitely must remain anonymous. Just like there is no transparency from usmle, they surely don’t want their beans spilled. Nice job

Do one with step 1 questions! That test asks about the most random factoids which we never use!

The point of these exams is to separate the surgeons from the PCPs....or so USMLE/AMA thinks. In reality, they create a really screwed up way of comparing medical students for residency positions where those who score average or below have essentially 0% chance of matching into a lucrative specialty. In the end, its all about salary and prestige.

Proof that it’s a business, not a training program. But how do you test, can you relate to patients in a way that gets them to open and say the buzzword, because Lord knows, it’s not going to be my physical exam of the spleen tip?

This is uWorld which we use at my school to study for step 1 so yes the questions are more theoretical and biochem based than practical, but I am surprised to hear even with that being said that practicing doctors find these irrelevant. Wish we focused more on what you are talking about. For example, so many questions talk about palpating the spleen lol

It might not be about core knowledge but it's about molding one psychologically to memorize rote and develop the strong work ethic necessary to be a doctor. It's akin to telling a boxer that all those thousands of miles you ran over the years during training camp were pointless because it's only a 36 minute fight.

Please do more this!

Not at all surprising. I am a Hospitalist who works on the front line. Our currency is clinical uncertainty because the knowledge base is forever shifting. We are asked to make binary decisions when the educational basis for deriving them is an amalgam of uncertainty. Beware the confident recommendation because those situations are honestly pretty unusual.

The ABP questions are horrible too, but we aren't allowed to even discuss or share their content, so it will never get fixed.

This was interesting and entertaining!

I am not a doctor, i just find medical stuff very interesting and wish i had gone that career path. I am curious - if you saw that last question in a real patient, why would you not do an infectious disease workup before looking at cancer? Or infectious disease along with another cause of the weird leukocyte counts

To the extent that practicing MD's study existing science and not create science, it is a process of socialization in school and experience afterward. Buildings for doctors in cities used to be called Medical Arts buildings. Also, listen to the lungs, even in a noisy ER.

We're starting interns now, the first thing I told them is that they have to ignore the BS they've just been taught and go see some real patients. A lot of them are from UCSF, they need a lot of help....

Once in my entire life I palpated a spleen. It was 3rd year, Gen Surgery, morning rounds, attending asked me to palpate the spleen. It was ten pounds. 😂

Please continue theisa series of board qs reviews!! We all need this.

Is there any effort today to improve the selection of questions for these tests in any professional licensure? As I attend medical lectures, I often say to myself, why is the lecturer spending any time on these obscure points when in real life practice this seems such a waste. I hope we can get better. How is it that ChatGPT is the best test taker?

A big reason I didn't go to med school, I wanted to become a doctor to help people not take exams, the test makers think they're very clever and I'm sure they'd only need 17 people to change a single light bulb. Research suggests it takes 17 people, in fact let's mandate it! 😉

I worked with preparing questions for medical students. Some professors dont like asking about the fundamental most important things because it is too "easy", and students often answer correctly. They especially love questions where the phrasing misleads you into an obviously "correct" answer which is wrong technically (although if you asked the student clearly they would likely know) When you test trivialities you get a wonderful normal distrubution curve. Its really not based on what will be useful.

Many doctors: Med students should know everything our committee of five know about our specialties. Please do not consider that none of us have much idea about what the other four members consider essential.

There is so much good evidence for abolishing medical licensing. Replace it with certification created by actual experts.

We can keep these… but not at the cost of everyday bread and butter stuff

Questions like "how can you continue charging your patient after the illness is gone?"

The questions are pretty dumb often - pretty random. However, the worst part is in my ongoing certification exams which often ask us trivia. I think the problem is that academics are nerds and trivia is easy. Trivia separates who studied from who didnt….determines who puts in some effort. But the doctors dont get paid for making these questions so trivia is quick and easy for them. My background is lots of stats and Epi so I will always give them feedback about these questions and have offered to write questions - but I am not in academics and am nobody. But the work involved to improve all these things is too much for volunteers who are busy managing grants, teaching, clinic, papers.

As someone who just completed step 2.I saw that low LAP score from a mile away.

Can I prescribe imatinib as general internist? No. So do I give a f** about whatever test… not at all!

The USMLE writers spelled fluorescence wrong.

👉🏽 Re question 1, what stands out to me is the almost imperceptible subtle brainwashing: 2:28 ‘and is compliant with medications’ So right off the bat the programming is - meds are needed and a given for the patient (aka no diet lifestyle needs be addressed), checking for adverse effects of meds not considered, contraindications not considered, etc. It’s just mentioned amidst other fact info, as a given, so casual that students don’t think to question. ‘does not use tobacco alcohol AIT drugs 2:28 and is compliant with medications 2:30 temperature is 992 blood pressure 128 2:32 over 82 pulse 88’ Blah blah and blah!

Acid Fast is for mycobacteria. I think the quest was implying TB

This was fun

Truth.

They dont really need to know the chromosome, really.

Lol its worse on the MCAT

lol why is this guy so mad about these questions. I do agree that some of these you are never going to need to know unless you go into that particular specialty, but there's no such thing as useless knowledge. The bar for passing step 2 is already low enough that even if you do not know more than half of these factoids you'd still pass.

I thought Step 1 was well -written and I actually enjoyed the 4-5 month game of preparing for it. I think students need to have a hurdle like this to jump over and sort them out based on pattern recognition ability, reading comprehension, medical knowledge, consistent commitment to a goal, and sheer determination. I never studied for Step 2 or 3 and did fine after the amount of work put into Step 1. I don't think USMLE should change anything.